Editorial Comment to Recent status of the treatment of stress urinary incontinence

Abstract

1SUI adversely affects quality of life for women, and urologists must have knowledge about trends in the treatment for this condition, especially in an aging society. In this article, the therapeutic options for SUI were described as conservative, pharmacological or surgical treatment. The main form of treatment for SUI could be the mid-urethral sling surgical procedure (tension-free vaginal tape [TVT], transobturator tape [TOT]) for many urologists. However, recent guidelines support the efficacy of supervised pelvic floor muscle training. 2 In terms of pharmacological therapy, the efficacy of duloxetine, which is the only drug licensed for use in this condition in Europe, was presented. Various non-surgical therapeutic options help in selecting the optimal treatment for SUI, and the establishment of new drugs and conservative therapeutic strategies will be welcomed for patients who elect not to undergo surgical treatment. As described by the authors, surgical procedures for SUI should be individualized to the patient, and depend on the type of SUI; for example, urethral hypermobility and intrinsic sphincter deficiency (ISD). For urethral hypermobility, recent studies showed good efficacy of the mid-urethral sling surgical procedure.The difference in clinical outcome betweenTVT and TOT is an interesting issue. However, similar subjective cure rates were shown in many studies cited in the present study. There were differences in the types and rates of complications between these procedures, and the results could have been due to the different routes of the sling. TVT might be effective for patients with ISD, 3 but urologists require an awareness of surgical indications for the mid-urethral sling surgical procedure. Good clinical outcomes and low rates of surgical complications supported the status of TVT and TOT as gold standard treatments for urethral hypermobility.